Competent patients who refuse life saving medical treatment present a dilemma for healthcare professionals. On one hand, respect for autonomy and liberty demand that physicians respect a patient’s decision to refuse treatment. However, it is often apparent that such patients are not fully competent.
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Do competent patients have a right to refuse medical treatment?
· The Dilemma of the Competent Patient Who Refuses Recommended Treatment. Ronald W. Pies, MD. Disclosures. July 13, 2017. 0. I recently had the privilege of commenting on a challenging case vignette ...
Is a patient who fails to follow good advice competent?
This article reviews recent case and statutory law concerning patients who refuse medical treatment. Among the special cases considered are: the competent adult patient who refuses treatment on religious or privacy grounds; the incompetent patient whose own wishes were never expressed, but whose family refuses treatment; the incompetent patient who expressed the …
How do you deal with a patient who refuses treatment?
· Where a competent adult refuses treatment recommended by guidelines, the doctor is bound to respect that refusal. If he does not, the doctor may face disciplinary action by the General Medical Council, plus possible civil and criminal proceedings in battery. Informed refusal, just like informed consent, comprises three elements:
Can the family of an incompetent patient assert the patient's rights?
Abstract. When patients require information to decide whether to accept recommended treatments, a question in both law and ethics is whether the same information is adequate whether they consent or refuse, or whether refusal requires more or repeated information. Refusals of recommended treatment can carry increased risks for patients' well-being and so …
Why is refusal of treatment an ethical dilemma?
In general, ethical tension exists when a physician's obligation to promote a patient's best interests competes with the physician's obligation to respect the patient's autonomy. “When you don't take your medication, you're more likely to get sick.”
How will you handle a patient refusing treatment you have recommended?
When Patients Refuse TreatmentPatient Education, Understanding, and Informed Consent. ... Explore Reasons Behind Refusal. ... Involve Family Members and Caregivers. ... Document Your Actions. ... Keep the Door Open.
Can a competent patient refuse treatment?
Competent patients have a right to refuse treatment. This concept is supported not only by the ethical principle of autonomy but also by U.S. statutes, regulations and case law. Competent adults can refuse care even if the care would likely save or prolong the patient's life.
What is it called when a patient refuses treatment?
Informed refusal is where a person has refused a recommended medical treatment based upon an understanding of the facts and implications of not following the treatment. Informed refusal is linked to the informed consent process, as a patient has a right to consent, but also may choose to refuse.
How would you respond to a client who refuses to take his her medication?
If the client refuses and gives no reason, wait a few minutes and then offer the medication again. If the client refuses again, try again in another few minutes before considering a final refusal.
Why do patients have the right to refuse treatment?
People may want to refuse medical treatment for several reasons, including financial, religious, and quality of life. People are often within their rights to refuse treatment, but some exceptions exist.
Who should you inform when a service user refuses to take prescribed medication?
If, for some reason, the person you care for is unwilling to take their medicines, talk to their GP or pharmacist. They may be able to suggest a form of the medicine that's more acceptable than tablets.
What is the nurse's legal and ethical responsibilities toward the patient who refuses medical care or treatment?
All clients have the legal right to autonomy and self-determination to accept or reject all treatments and interventions. With the exception of emergencies, all aspects of nursing care and interventions must be explained to the patient.
What is a competent patient?
The Mental Capacity Act 2005 defines a competent patient as one who is able to take a decision for himself, i.e. who can understand and retain the information relevant to the decision, weigh that information as part of the process of making the decision, and communicate that decision (s 3(1).
What is meant by a patient refusing or withdrawing treatment?
A decision to withhold or withdraw life- sustaining treatment is a common feature of medical practice when caring for people who are approaching the end of life. 2. A person who has capacity can lawfully refuse treatment even if that treatment is needed to keep them alive. Such a refusal should be followed.
What is a patient informed refusal?
Informed refusal is an attempt to balance the provider's duty to care for patients with respect for patient autonomy and patients' right to self-determination—a balance that has been evolving over time and varies among both state statutory and case law.
What should a doctor do if a patient refuses life saving treatment for religious reasons?
Three physician experts suggest that to discern when to accommodate a patient's refusal of treatment on religious grounds, doctors should embrace medicine's traditional orientation toward preserving and restoring health.
What are a few examples of when a patient can refuse treatment?
1 Accordingly, the patient may refuse to be informed about their medical condition and make a decision. An example would be the statement, “I don't want to hear anything from you. I'm not going to the hospital.” They may be informed and then refuse to make a decision. “Wow, that sounds bad either way.
How would you encourage a patient to take medication?
There are several ways to increase motivation to take medication as prescribed.Think about why you are taking the medication in the first place. ... Track progress in a journal. ... Take your medication at a similar time each day. ... Use a medication planner/pill box. ... Enlist family and friends to help with these strategies.
What happens if a doctor refuses to give informed consent?
If he does not, the doctor may face disciplinary action by the General Medical Council, plus possible civil and criminal proceedings in battery. Informed refusal, just like informed consent, comprises three elements: The patient must be competent. He or she must have sufficient information to be able to make a choice.
What is competent adult patient?
Adult competent patients are entitled to accept or reject treatment options. Their reasons do not have to be sound or rational; indeed, they do not have to give any reasons at all. Where a competent adult refuses treatment recommended by guidelines, the doctor is bound to respect that refusal. If he does not, the doctor may face disciplinary action ...
What is an advance refusal of treatment?
Patients may also make advance refusals of treatment – more commonly known as living wills or advance directives. These are statements made by patients when competent about how they wish to be treated should they become incompetent at a later stage.
Why was a blood transfusion necessary for Miss T?
Because of various complications, a blood transfusion was considered necessary, and was administered while Miss T was in a sedated and critical condition.
Did Miss T want a blood transfusion?
The day following admission, Miss T announced that she did not want a blood transfusion, although at that time no transfusion had been contemplated. However, later in the day, she went into labour and the baby was delivered by caesarean section.
What is the duty of care after refusal?
Discharging the duty of care following refusal requires the doctor to provide treatment, promoting the patient's best interest but within the limits of the patient's consent.
What is the duty of a doctor?
The duty on the doctor is to ensure that patients understand the implications of their proposed course of action. Information must be provided in objective terms, if necessary recruiting colleagues with special expertise to provide further advice, but scaremongering is out of the question.
What is the right to refuse treatment?
Competent patients have a right to refuse treatment. This concept is supported not only by the ethical principle of autonomy but also by U.S. statutes, regulations and case law. Competent adults can refuse care even if the care would likely save or prolong the patient’s life. 1 As Mahowald notes, “Respect for patient autonomy trumps beneficence and nonmaleficence.” 2 In this case, the FP did what he could. He fully explained his understanding of the situation, the benefits of obtaining assessment and treatment and the risks of refusal. He sought reasons for the patient’s refusal and had an open discussion using beneficent persuasion to determine if the patient might reframe his attitude and agree to the referral.
What is tension between autonomy and beneficence?
In the current case, the patient out-and-out refused care while, in the other case, the patient influenced the physician to modify his recommendation for hospitalization and convinced him to treat her as an outpatient. The cases are also similar in that good, objective documentation by the physician gave a sufficiently clear picture of what happened and allowed the malpractice allegations to be dismissed.
Did the FP repeat urinalysis?
The FP asked if the patient had seen the urologist. The patient said no. The FP did a repeat urinalysis at this May visit, which again showed trace blood. The physician called the patient and urged him to follow up with a urologist. The patient declared that he would not go to see a urologist.
When treatment over a patient's objection would be appropriate?
KP: A simple example of when treatment over a patient’s objection would be appropriate is if a psychotic patient who had a life-threatening, easily treatable infection was refusing antibiotics for irrational reasons. Treatment would save the patient’s life without posing significant risk to the patient.
What are the first few questions in a treatment plan?
The first few questions consider the imminence and severity of the harm expected to occur by doing nothing as well as the risks, benefits, and likelihood of a successful outcome with the proposed intervention. Other questions consider the psychosocial aspects of this decision—how will the patient feel about being coerced into treatment? What is the patient’s reason for refusing treatment? The last question concerns the logistics of treating over objection: Will the patient be able to comply with treatment, such as taking multiple medications on a daily basis or undergoing frequent kidney dialysis?
Is there anything out there to help health care professionals approach the problem of delivering medical treatment against the wishes of patients
And there are fairly clear policies and laws concerning the ethics and legality of delivering psychiatric care to patients who refuse it. But there is nothing out there to help health care professionals approach the problem of delivering medical treatment against the wishes of patients who lack decisional capacity.
Can you force dialysis on a patient who resists?
As Dr. Rubin stated, one cannot force three times weekly dialysis sessions on a resistant patient even if it means that the patient will die without the treatment.
What happens when a patient refuses treatment?
When patients refuse recommended treatments, physicians are apt to worry not just about their patients’ health and if they are doing everything they can to help them, but also if they will be to blame if the patient suffers a poor outcome. Continue Reading. This problem is neither new nor uncommon.
What is the ethical obligation of a physician to refuse a patient's care?
But respecting a patient’s right to refuse does not address another core obligation of medical practice: how to help patients promote their health.
What is harm reduction in healthcare?
Practicing harm reduction means identifying other medically acceptable options that the patient is willing to accept. 2 It does not mean suggesting treatment options that are not in accord with accepted standards of medical practice. Doing so would threaten the integrity of the medical profession because it would harm patients without a potential for benefit. Identifying other medically acceptable options that are preferable to the patient maintains the treatment alliance and promotes the patient’s health more than doing nothing. 3 For example, a patient who wishes to leave the hospital AMA may be behaving in way that undermines his or her health. But if a clinician can arrange follow-up with the patient’s primary care provider in 24 to 48 hours, the patient may find that preferable to continued hospitalization and will keep that patient engaged in care.
What is harm reduction?
Harm reduction. Harm reduction maintains the therapeutic relationship while helping to promote a patient’s best interests. It attempts to reduce the adverse health consequences that may come from a patient’s unhealthy behaviors while accepting that such patients are likely to continue these behaviors.
Why do patients decline treatment?
The most common reason patients decline recommended care is because they lack information. 1 In these cases, a physician’s ethical obligation is to ensure patients understand exactly what they are declining. This includes clarifying the indication for the treatment, its risks and benefits, any alternatives, and the risks and benefits of the alternatives. Often, patients can be persuaded to agree to a beneficial treatment simply by identifying the source of their misunderstanding and correcting it.
Do patients want their doctors to decide for them?
At the same time, patients do not necessarily want their physicians to decide for them . Such paternalism, when physicians make unilateral decisions about what is best for patients, is no longer ethically acceptable.
What are the conflicts that arise over other declinations of care?
More commonly, conflicts can arise over other declinations of care, including non-adherence with medication, treatment, or screening recommendations, by disengaging with their health care providers, or failing to follow-up regularly.
Why is Mrs X refusing treatment?
Mrs X is 35 and is in need of dialysis. She is refusing treatment because she is scared of the treatment which she believes is invasive. She has been counselled about the nature of the treatment - there are no alternatives that would be of practical benefit. She is competent to make treatment decisions.
Is Mrs X competent?
Mrs X is competent and so has autonomy to make treatment decisions. If the principle of respect for autonomy is given the highest value then her refusal should be respected despite the resulting harm. It is clear that she considers invasive long term treatment not to be in her best interests. It is important however that Mrs X is making an informed ...
Is Mrs X an informed decision?
It is important however that Mrs X is making an informed decision - a decision made in ignorance could not be said to be an autonomous one (although arguably a patient makes an autonomous choice if he delegates his decision to the clinician/ healthcare professional).